A missed opportunity – Scotland’s new Mental Health Strategy

Statement from Scottish Care:

The Scottish Government launched its much awaited Mental Health Strategy on the 30th March.

It has a great deal which is positive within its 40 action points including increasing the mental health workforce in A&E, GP practices, police stations and prisons and reviewing counselling and guidance services in schools. In particular we welcome the planned reform of the adults with incapacity legislation so that it complies with the best international human rights standards.

However as an organisation with the rights and dignity of older persons at our core Scottish Care regrets the lack of focus in the Strategy on the mental health needs of our older population.

When the Mental Health Framework was published last year, Scottish Care with others welcomed its particular focus on the lifespan especially its recognition of the needs of older persons. We see little of this reflected in the Strategy.

Our ageing population will and its increase by 86% by 2037 will inevitably mean a higher proportion of those with mental health needs being over the age of 65 and also a higher proportion of these individuals requiring the support of elderly care services. It is therefore crucial that we ensure high quality mental health care and support is built into the provision of these services, which nearly 100,000 people across Scotland access. To fail to adequately recognise, plan for and seek to improve the mental health needs and supports for this population through the Strategy would amount to a serious human rights and equalities issue. We are not convinced the published strategy achieves this.

Scottish Care regrets the complete lack of a dedicated focus on the mental health needs of older Scots in the new Strategy. We are calling for more focussed work to identify the current gaps in support for older people with mental health conditions including social care gaps,
and prioritised support and training of staff in care services to deliver positive outcomes for individuals with mental health conditions.

Scottish Care has identified four areas where we believe more specific attention needs to be paid to mental health priorities for both older people and individuals receiving and working in social care services:

1.
Recognising mental health conditions in older people as wider than dementia.

Whilst dementia is an undoubtedly crucial element of mental health which the Strategy rightly recognises, it is important to recognise that the spectrum of mental health conditions that an older person may be living with is much wider and these conditions may even be undiagnosed. By narrowing our lens to dementia support only, we risk failing to improve the availability, appropriateness and quality of support for older people living with other conditions, including but not limited to depression, anxiety, eating disorders, bipolar disorder, schizophrenia. The fact that people are living longer does not diminish the range of conditions they may be living with nor the requirement for tailored, effective support to be available to those over 65.

2.

Ensuring appropriate support for those living with enduring mental health conditions who access social care services

One of the current shortcomings of mental health care and support which the new Strategy does little to acknowledge is the way in which both formal and informal support is available to individuals when they start receiving social care services, particularly within a care home setting. The current infrastructure and professional relationships between care services, GP services, pharmacy services, Allied Health Professionals and primary care mean, at best, multi-disciplinary support to individuals in care homes settings is a postcode lottery.
Additionally, more effective planning needs to be in place to ensure those who have moved into a care home setting can have continuation of community support available to them before they entered the care home. Finally, care home staff do a fantastic job in promoting personalised care to deliver positive outcomes for residents, but there may be additional support and training they need to ensure they fully understand how best to support individuals living with different mental health conditions. The integration of health and social care certainly presents opportunities to improve shared learning, multi-disciplinary and cross-sector working, better professional dialogue and person-centred rather than location-centred care, but this will require culture change which could be progressed more effectively by recognising it through the Strategy.

3.

Awareness of the risk of developing mental health conditions in periods of transition, change and trauma, particularly in older age

As well as the current challenges around effectively supporting older people with enduring mental health conditions, it is important to recognise the particular factors relating to older people and social care which may prompt or exacerbate mental health conditions. For instance, older people are more likely to experience bereavement through the loss of friends, spouses and relations which can require mental health support. Additionally, individuals who go through transitions such as moving into a care home or another care setting may experience difficulties in adjusting to a loss of home or a perceived loss of identity. It is therefore crucial that we recognise the risk factors and pressure points for older people, where they may require additional expert support in order to maintain or restore positive mental health.

4.

Transitions between adult services and older peoples services

The new Strategy recognises the particular risks faced by young people moving into adulthood – it does not do the same for the move from adult to older persons services.
As articulated in the above two points, there are risks to positive mental health associated with transitional phases and it is recognised that transition phases can lead to a breakdown in communication and quality of care and support, leading to further uncertainty and anxiety for individuals at the centre of that support.

Scottish Care believes that, as a society, we still have an inherent inequity in older people’s care and support compared to other types of care and support and unfortunately, discriminatory practice can still prevail. Whilst positive progress is being made around outcomes and personalisation, and human rights-based approaches can support this, there remain challenges for how we support older people with mental health needs to live well and what resources (including funding) are available within older people’s services to do this effectively. Attention must therefore be paid to how we support people with mental health needs through care transitions effectively so that they do not experience a diminishing of quality support based on their age or location.

Whilst the new Strategy is a clear step in the right direction it is nevertheless still falling short.
Scottish Care would want to see more explicit actions relating to older people and social care to ensure that real progress is made through the strategy in addressing their mental health care and support provision challenges.

Scottish Care will be commencing a piece of work in autumn 2017 exploring the unmet mental health needs of older people in receipt of social care services. This work will explore both what these unmet needs are and what needs to be in place to address these gaps, whether they relate to awareness and understanding, care and support availability and appropriateness, or staff capacity, skill mix and training.

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